[Une combinaison très rare de thrombose veineuse et artérielle chez un patient atteint du COVID 19]. / A very rare combination of venous and arterial thrombosis in a patient with COVID-19.

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. This epidemic has caused serious socio-economic problems worldwide, with a very high mortality rate. Several articles have been published in the literature showing the consequences of this disease on the human body. Among the most serious complications are venous and arterial thrombosis, which are rarely observed together in the same patient. In this article, we report an exceptional case of a patient with COVID-19 with the combination of intracardiac thrombus (left atrium) and venous thrombosis (splenic vein and portal trunk).

Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report.

Introduction: Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation: The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion: Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion: Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.

Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report.

Introduction: Central venous Occlusion (CVO) is a serious complication that occurs mainly in patients with long term central venous catheters for dialysis. It remains a challenge in vascular surgery. Case presentation: We report a case of a patient with end-stage kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava and underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. Clinical discussion: Central venous catheters remains the main cause of CVO in ESKD. Although the endovascular therapy is the main approach in the treatment of CVO, the surgical bypass to the RA is often the last resort to preserve vascular access in hemodialysis patients. The autologous vein and bovine arterial bypass remains better than PTFE grafts in terms of long term patency. Conclusion: fistulas as a first approach for dialysis access must be privileged at the expense of central catheters. However bypass to RA by mini thoracotomy incision remains as an excellent option for dialysis access in ESKD with CVO.

Endovascular treatment of acute aortic isthmian ruptures: case study.

Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patient's admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.

Heart valve surgery in patients with homozygous sickle cell disease: A management strategy.

BACKGROUND: Patients with the homozygous sickle cell disease have increased perioperative mortality. Some indications like heart valve surgery, may justify an exchange blood transfusion to reduce the proportion of hemoglobin S (HbS) and complications. SUBJECTS AND METHODS: We report two female cases aged 20 and 27, of African origin with homozygous sickle cell anemia who underwent heart valve surgery to treat mitral valve regurgitation. This presentation describes the perioperative considerations including anesthesia and postoperative care. RESULTS: A partial exchange blood transfusion decreased HbS levels from respectively, 90% and 84%, 9% to 27% and 34%, and simultaneously treated the anemia. Neither sickling crisis nor acidosis occurred in any patient, and no special postoperative complication occurred. Average hospital stay was 10 days. Currently, the two patients remain alive and free of cardiac symptoms. DISCUSSION: Although the presence of sickle cell disorders is associated with increased risk of sickling and thus vaso-occlusive complications, they should not be taken as a contraindication for heart valve surgery. Nevertheless, monitoring of certain parameters such as venous, arterial oxygen content, pH, and body temperature is mandatory for a better outcome. Furthermore, preoperative exchange transfusion has a positive influence on the outcome of surgery and on the survival of patients undergoing heart valves surgery. Avoiding intraoperative hypoxia, hypothermia, and vaso-constrictive agents, minimizing HbS levels with preoperative exchange transfusion, and ensuring a stress-free environment with the judicious use of sedatives made surgery relatively safe in these cases.

The risk of performing cardiopulmonary bypass in malaria patients: a small case series.

The effects of cardiopulmonary bypass on patients who have active or dormant malaria are unknown. What is known is that malaria-induced hemolysis can be exacerbated by cardiopulmonary bypass. We report 3 cases in which patients with active or dormant malaria underwent open-heart surgery. Two of them received quinine prophylaxis, and the 3rd patient (who presented with an active infection) received longer-term preoperative treatment with quinine. In all 3 cases, the surgery was performed uneventfully. We suggest preoperative quinine prophylaxis for patients with a history of malaria whose blood smears are negative for parasites, and we advocate more radical preoperative treatment with quinine for patients whose blood smears are positive at presentation. These measures appear to prevent hemolysis and fever during both the preoperative and postoperative periods. However, there is need of a multicenter study to ascertain the actual effects of cardiopulmonary bypass on patients with malaria.